Market Size and Facility Count
There are approximately 15,000 Medicare and Medicaid certified skilled nursing facilities operating in the United States. Together they represent roughly $130 billion in annual revenue, making post-acute care one of the largest segments of the broader healthcare market.
The market is highly fragmented. The largest operators control a few hundred facilities each, but the majority of SNFs are operated by regional or independent operators running fewer than 10 locations. This fragmentation is both a challenge and an opportunity for vendors — there's no single customer that controls the market, but there are identifiable clusters of ownership that allow for efficient portfolio-level selling.
Ownership and Operator Landscape
- Approximately 70% of SNFs operate on a for-profit basis
- Roughly 25% are non-profit, often affiliated with religious or community health systems
- The remaining ~5% are government-owned
- Private equity-backed operators now control an estimated 5-10% of the total facility count, with concentration in certain regional markets
- The top 10 operators by facility count represent roughly 10-12% of the total market
This ownership distribution matters enormously for vendors. For-profit and PE-backed operators tend to be more commercially oriented and faster moving on vendor decisions. Non-profits often have longer sales cycles and more committee-driven procurement processes.
Staffing: The Market's Defining Challenge
- SNFs employ approximately 1.5 million workers nationwide, making the sector one of the largest healthcare employers in the country
- Annual CNA turnover rates average over 50% industry-wide, with some facilities exceeding 100%
- The average facility spends 60-70% of its operating revenue on labor
- CMS's minimum staffing rule — finalized in 2024 — requires a minimum of 3.48 total nurse staffing hours per resident per day, a threshold many facilities currently fail to meet
For staffing companies, workforce technology vendors, and anyone in the labor supply chain, these numbers describe a market under structural pressure that is likely to persist for years.
Occupancy and Census Trends
SNF occupancy has been recovering from the significant declines experienced during the COVID-19 pandemic, but has not fully returned to pre-pandemic levels industrywide. Average occupancy rates sit in the low-to-mid 70% range nationally, compared to the mid-80s before 2020.
Occupancy varies significantly by:
- Geography — Urban markets with strong hospital referral relationships tend to outperform rural facilities
- Star rating — Higher-rated facilities consistently run higher occupancy
- Operator quality — Best-in-class operators maintain occupancy well above market averages even in competitive markets
Reimbursement: The Revenue Engine
SNF revenue comes from three primary sources:
- Medicare — The highest-paying payer, reimbursing for short-term post-acute care following a qualifying hospital stay. Medicare patients typically represent 15-25% of a facility's census but a disproportionate share of revenue.
- Medicaid — The dominant payer by census volume, covering long-term care for residents who have spent down their assets. Medicaid rates are set by states and vary widely — from roughly $150/day in low-rate states to over $300/day in high-rate states.
- Private pay and other — Includes private insurance and out-of-pocket payment. Typically a small percentage of census but highest margin.
The Data Opportunity
What makes the SNF market particularly interesting from an intelligence perspective is the volume of publicly available data CMS publishes. Staffing hours, star ratings, survey deficiencies, ownership records, and quality measures are all available at the facility level — updated regularly — for every certified facility in the country.
The vendors and investors who are winning in this market aren't just working harder. They're working from a more complete, more current picture of the landscape than their competitors have access to.
